Fluoroscopic guidance for placing a needle or catheter, such as for a biopsy, aspiration, injection, or localization, billed alongside the primary procedure.
- Medicare
- $121.25
- Work RVU
- 0.53
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Primary procedure performed and its code
- Statement that fluoroscopy was used to guide the needle
- Saved image or description of needle position
- Contrast used, if any
- Laterality and site
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
Fluoroscopic needle guidance, 77002, carries a ZZZ global, which means it is only paid with a primary procedure. In ortho, the common pairs are arthrography injections: 23350 for the shoulder, 27093 for the hip, 25246 for the wrist, 24220 for the elbow, and 27648 for the ankle, when the injection is for a CT or MR arthrogram. If a conventional arthrogram is also read (73040, 73115, 73525, and the like), the fluoroscopy is part of that read and 77002 is not added.
The list of codes it cannot go with is where denials come from. CPT instructs against reporting 77002 with the joint injection codes 20600 through 20611. A fluoroscopically guided knee injection is 20610 alone. Spine injections such as epidurals, facet injections, and sacroiliac joint injection with 27096 include imaging guidance in the primary code, so 77002 is not added.
The practice that owns the C-arm bills globally. In a hospital or ASC, the physician bills with modifier 26. Keep a saved fluoro image or a clear statement of needle position in the procedure note.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.53) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.63) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.53 |
| Practice expense RVU | 3.06 |
| Malpractice RVU | 0.04 |
| Total RVU | 3.63 |
| Medicare national rate | $121.25 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $121.25 |
Common denial reasons
The recurring reasons claims for CPT 77002 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed with 20600 through 20611
- Billed with spine or sacroiliac injection codes that include guidance
- No primary procedure on the claim
- No documentation of the fluoroscopic image or needle position
- Billed with a conventional arthrogram read (73040, 73115, 73525) that already includes the fluoroscopy
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can I bill 77002 with 20610?
02Which orthopedic codes can 77002 be billed with?
03Is 77002 billed with sacroiliac joint injections?
04Is 77002 an add-on code?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe notes capture the physician's description of needle placement under fluoroscopy alongside the procedure, supporting guidance when it is separately payable.
See how Mira captures CPT 77002 documentation